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Spinal Shock
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
Treatment of SCIs begins at the accident scene with proper spinal immobilisation, which should include a rigid cervical collar and transport on a firm spine board with lateral support devices. The patient should be rolled with standard logroll techniques with control of cervical spine. Spine boards should be used for transport only, and patients should be removed when clinically safe, as decubitus ulcers can occur after only 30–60 minutes on a backboard.
Maternal Cardiorespiratory Arrest
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Nilmini Wijesuriya
A tilt of 15° to the left relieves aortocaval compression by the gravid uterus. Effectiveness of chest compressions declines with greater angles of inclination. According to the situation, the tilt can be achieved by: the tilting of the operating table, a Cardiff wedge or an upturned chair back used as a wedge below the woman. Alternatively, the tilt can be achieved by someone kneeling on the right side of the woman and then placing their knees underneath the woman’s thorax. Rolled-up towels or pillows underneath the woman do not provide the desired firm surface suitable for counter-pressure when performing chest compressions, and therefore, should not be employed. In cases of major trauma, if a wedge is used, it should be placed below the spinal board.
Neurotrauma in the Field
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
It is not recommended to place a collar on any patients with a penetrating injury as this will compromise the assessment of the wound and may contribute towards airway obstruction. Similarly, in a patient involved in a blast injury, the high likelihood of airway obstruction and lung injury from barotrauma is a contraindication to the use of a collar. Therefore, as a general rule, military patients with suspected spinal injuries should be immobilised either manually or with blocks and tapes alone. A spine board is helpful in transferring the patient efficiently whilst maintaining alignment, but there is an elevated risk of pressure sores even if only used for a brief period, and the spine board will contribute significantly to hypothermia in a polytrauma patient. These need to be considered when immobilising such patients.
Demonstration of pressure reduction in a new proof of concept spine board
Published in Assistive Technology, 2021
Helen Sun, James Wilson, Mary Joan Roach, Mohamed Samir Hefzy, Greg Nemunaitis
Two different spine boards were tested: an SSB and P-5. The SSB studied was a Pro-Eco spine board (Rapid Deployment Products Inc.) without modification. The spine board measured 72” x 16” x 2.25” with a weight of 14.2 pounds (Figure 3). P-5 was constructed from a Pro-Eco Spine Board (Buddemeyer, Gladieux, Hillegas, Ruck, Walton, Nemunaitis, Hefzy. Pressure Reducing Spine Board. MIME 4200 Senior Design Clinic. Spring 2017). A 65” contoured section of the HDPE shell and polyurethane core was removed from the center of the spine board located 1.5” down from the top hand hole (Figure 3). The cut out was 8” at the top and contoured to 6” at the bottom at a depth of 1”. Two types of foam were used to cover the cutout. The bottom layer was a 1” thick piece of Lux Regular foam (Foam Factory Inc., Macomb, MI, USA) with a density of 1.80 lbs/ft3 that filled the 65” contoured cut out in the spine board (Figure 3). The top layer was a 1” thick piece of HD-36 Regular foam (Foam Factory Inc.) with a density of 1.80 lbs/ft3 that was contoured to the shape of the board with the cut out measuring 68” in length and 12” in width at the top and 11” in width at the bottom (Figure 3). The foam insert was covered with a Sure-Check Fusion III-HP fabric (Herculite Inc., Emigsville, PA, USA). Table 2 reviews the available material properties of Lux Regular foam and HD36 Regular foam. P-5 measured 72” x 16” x 2.25” with a weight of 12.5 pounds.
Cervical Spine Motion During Vehicle Extrication of Healthy Volunteers
Published in Prehospital Emergency Care, 2020
Alberto Gabrieli, Francesca Nardello, Michele Geronazzo, Pierpaolo Marchetti, Alessandro Liberto, Daniele Arcozzi, Enrico Polati, Paola Cesari, Paola Zamparo
Although some studies highlight the fact that spinal injuries deriving from road accidents are relatively rare (6), according to some authors, from 2% to 25% of spinal cord lesions could be secondary to the treatment and/or the transport of the trauma patient (9, 10). At present, several guidelines regarding the treatment of trauma patients are available and most of them agree on the importance of spinal motion restriction (SMR) in each phase, from accident site to hospital (11, 12), although a recent joint position statement confirms that the routine use of SMR is not the current position of literature (13). Spinal motion restriction devices, including cervical rigid collars (14, 15), long spine boards (16–18), Kendrick Extrication Device (KED) (19), and advanced devices such as the Ferno XT™, are designed to prevent passive and active spine movements after trauma (20), but their use is still associated with some issues such as pain and skin pressure ulcers (21), unwanted spinal movements and suboptimal placement of the devices (19, 22). Indeed, some studies currently state that traditional spinal immobilization using long spine boards is no longer recommended for routine prehospital use (23, 24).
Prehospital Cervical Spine Motion: Immobilization Versus Spine Motion Restriction
Published in Prehospital Emergency Care, 2018
Erik E. Swartz, W. Steven Tucker, Matthew Nowak, Jason Roberto, Amy Hollingworth, Laura C. Decoster, Thomas W. Trimarco, Jason P. Mihalik
Indeed, two studies have questioned the long spineboard's effectiveness to even achieve immobilization (9, 10). Other research reported less capability of the spineboard to control spine motion compared to a vacuum mattress (11), scoop stretcher (12), and to a padded litter used for air transport (13). One study compared TSI to SMR for lateral motion control (only) during simulated hospital transport in an ambulance (14) and reported superior motion control when subjects were secured to the stretcher mattress without a long spineboard. However, no research exists comparing TSI to SMR in limiting three-dimensional head and neck motion throughout the entire spine-injured patient's acute, pre-hospital management experience. Generating additional evidence to support these protocol changes is paramount to enhancing patient safety and adoption of emerging SMR protocols.